Transforming mental health care with cultural narratives and metaphors

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In a groundbreaking academic article, Laurence J. Kirmayer, a leader in the field of cultural psychiatry from McGill University’s Division of Social & Transcultural Psychiatry, calls for a fundamental shift in how we understand mental health.

His paper, “Cultural Poetics of Illness and Healing,” advocates for an approach deeply rooted in the psychological humanities, exploring the complex interplay between language, metaphor, and the healing process.

“Our own self-understanding through metaphors and narrative constructions plays a key role both in internal regulation and in engagement with our social environments, which are largely constituted by ongoing interactions with others. The language we have available to articulate and express our experience changes the very nature of that experience. This is the case even for seemingly obdurate experiences of pain and suffering, no less than for the stories we borrow or invent to carry on our lives and project ourselves into new and better circumstances,” Kirmayer writes.
“The implication is that an adequate picture of the emergence of illness experience and its transformation through healing practices must lay bare the embodied processes of imagination as well as the social processes of self-construal and positioning through pragmatic, material, and discursive engagements with the cultural affordances that constitute our local worlds and niches. While much of this process of meaning-making is organized by and communicated through narratives, metaphors play a central role in efforts to make sense of symptoms and suffering for both patients and healers.”

At the heart of Kirmayer’s research is the idea that our understanding and experience of mental health are significantly shaped by the cognitive science of language and metaphor, combined with cultural influences. This approach highlights the crucial role of metaphors in both expressing and comprehending mental health issues. By delving into the concept of ‘poiesis’ — the act of creation through language — Kirmayer illustrates how our worldviews and methods of coping with suffering are intricately crafted through this process.

Kirmayer’s work reveals how individual and collective narratives, deeply ingrained in cultural history and community, crucially influence our experiences, expressions, and healing from mental and emotional distress. He argues that metaphors, deeply embedded in our cultural and personal backgrounds, shape how we perceive and articulate mental health challenges. These metaphors act as cognitive tools, providing new perspectives on familiar situations and influencing our thoughts and actions.

The article by Kirmayer presents a unique perspective on how language, particularly metaphor, plays a critical role in our comprehension and experience of mental health. According to Kirmayer, language is not just a means of communication but a tool through which we shape our understanding of illness and healing. The article discusses the concept of ‘poiesis’ – the act of creation through language, which he believes is instrumental in shaping our lifeworlds, allowing us to express our suffering and seek recovery.

It emphasizes that each culture has a unique language of suffering with its own metaphors rooted in specific histories, geographies, and communities. The article’s core argument is that metaphors play a central role in understanding and responding to mental health challenges. Metaphors are bridges that connect our physical experiences and emotions with more complex concepts. It is not just semantic but a complex process where metaphors can evolve and generate new meanings, influencing our thoughts and actions.

For example, metaphors can transform how we view certain experiences or emotions, giving them new connotations and implications. They can serve as cognitive tools, providing new perspectives on familiar situations and thus shaping our understanding and actions. Kirmayer believes that this process of metaphorical thinking is crucial in psychiatry and psychology as it affects both the patient’s and therapist’s understanding of the illness and recovery.

In exploring the ‘cultural poetics’ of illness, Kirmayer emphasizes the importance of metaphoric embodiment, demonstrating the interconnectedness of physical and discursive processes in our health experiences. Drawing from 4E cognitive science, he shows a reciprocal relationship between our bodily states, cognition, and the social discourse we partake in.

Kirmayer argues that active inference plays a crucial role in our linguistic processes by helping us predict future scenarios and imagine possible situations, which in turn helps us navigate the social world. However, he notes that computational models of metaphor in active inference do not fully capture the richness of meanings that are derived from cultural histories and contexts.

Kirmayer also addresses the shift in the DSM-5 from the notion of culture-bound syndromes to cultural concepts of distress, highlighting the complexity of symptom experience. He explores how cultural explanations of illness often rely on metaphors rather than fully elaborated models. This focus brings to light the significance of metaphors in embodied experience, symptom production, and coping mechanisms.

In addition, Kirmayer delves into the transformative power of metaphors in psychotherapy, illustrating how therapists use them to reshape patients’ understanding and responses to emotional and behavioral problems. He discusses the impact of colonialism on language and metaphors and emphasizes the importance of culturally informed therapies, like Psychohistoriographic Cultural Therapy in Jamaica.

His article also underscores the critical role of metaphor in medical education and practice. He advocates for a deeper understanding of the metaphors used in medicine to enhance the connection between practitioners’ and patients’ experiences. This concept extends to social poetics in medical education, focusing on understanding patients’ stories and lifeworlds beyond clinical diagnoses.

Kirmayer’s work offers a profound insight into the complex relationship between language, culture, and mental health, underscoring the need for a more nuanced understanding of mental health care that transcends traditional biomedical approaches.

 

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Kirmayer, L. J. (2023). Cultural poetics of illness and healing. Transcultural Psychiatry, 60(5), 753-769. https://doi.org/10.1177/13634615231205544

 

Editor’s Note: Part of MITUK’s core mission is to present a scientific critique of the existing paradigm of care. Each week we will be republishing Mad in America’s latest blog on the evidence supporting the need for radical change.

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MIA-UMB News Editor: Justin Karter is a writer, researcher and community organizer with graduate degrees in both journalism and community psychology. He is a doctoral candidate in Counseling Psychology at UMass Boston, an active member of the Society for Humanistic Psychology, and is currently working on several scholarly projects at the intersection of psychology, social theory, and political philosophy.

1 COMMENT

  1. Thank you Justin for this very interesting article. I strongly feel language is very important too. Many Mental Health patients should have access to their notes to read what has been documented about them. They invariably have jargon, poor spelling and bad grammar. They reflect very little of what the patient has to say. There are assumptions, suppositions and often are incorrect. Nowadays, the majority of Integrated Care Boards, Trusts and Health boards use the Civica Records System which was formerly the Organisation for Economic Co-operation and Development‘s Patient-Reported Indicator Surveys. The PURPOSE of this piece of SOFTWARE is to LISTEN to patients. Therefore, psychiatrists, psychiatric nurses, occupational therapists, social workers must record what the patient is telling them. Yet, they FAIL to, they use their own ‘language’ and write absolute nonsense. There are no Patient Reported Experience Measures and no Patient Reported Outcome Measures. These can be translated and analysed by a professional called a Clinical Coder into alpha-numerical strings. They feed into many other STATISTICS such as Financial Aspects and Commissioning. So, the planning of services. Yet, Mental Health workers document a way a person is dressed, how fast they speak and whether good eye contact is maintained. There lies a very serious problem they simply DO NOT LISTEN. From a legal point of view, the inaccuracies and tardiness of records make them very difficult to defend in a court of law. There are many laws regarding data. INFORMATION GOVERNANCE is a large legal framework. Communication is a tool and many of us communicate via computers. Previously, I was a Software Engineer, so the industry I was in used ‘jargon’.
    Kirmayer may believe in metaphorical thinking for psychiatry and psychology. However, the stark reality of what actual happens is patients are bullied, harassed and intimidated by those in the field. Any human display of emotion is seen as abnormal and must be treated with drugs. Often they refuse to believe patients because they are seen as liars. They cause harm and refuse to believe they are doing a thing wrong. The notes on the other hand speak volumes.
    We do need to be realistic, there is no room for idealistic opinions. Psychiatrists have been trained this way and have behaved this way since the beginning of time. I really would like to know why they were drawn to the profession in the first place. Many of their medical colleagues believe them to be lower in status than them. Maybe they just did not make the grades and it is their own insecurities which make gives them the attitude of ‘I’m not wrong (again) I can’t be. Oh no not again. I have failed. I have to insist I am right, no matter what.’ They are part of a system of social injustices which as an Auditor, I can very easily prove.
    I may suggest visiting several psychiatric hospitals and Community Mental Health Clinics, you will see how patients really are treated.

    Kind regards